Provider Demographics
NPI:1306871827
Name:PIANO, THEODORE JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOSEPH
Last Name:PIANO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 HANGING MOSS CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-7658
Mailing Address - Country:US
Mailing Address - Phone:904-292-0665
Mailing Address - Fax:904-292-0665
Practice Address - Street 1:4142 HANGING MOSS CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-7658
Practice Address - Country:US
Practice Address - Phone:904-292-0665
Practice Address - Fax:904-292-0665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3080213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP03080OtherFLORIDA LICENSE NUMBER
FLT83326Medicare UPIN
FLU2251AMedicare ID - Type Unspecified